Nonablative Fractional Resurfacing Research Articles

Adverse events associated with 1540-nm nonablative fractional resurfacing in darker skin: A retrospective study

Adverse events associated with 1540-nm nonablative fractional resurfacing in darker skin: A retrospective study

Clinical Factors Affecting the Effectiveness of 1550-nm Erbium-Doped Fractional Photothermolysis Laser for Individual Atrophic Acne Scar Types.

Although non-ablative fractional resurfacing is frequently used for atrophic acne scars, few studies have examined clinical factors affecting the effectiveness of non-ablative fractional laser in individual atrophic acne scar types (icepick, rolling, and boxcar scars). Herein, we evaluated the clinical factors affecting the effect of non-ablative fractional laser for individual atrophic acne scar types using objective assessment tools. Thirty-one patients who had been treated by 1550-nm erbium-doped fractional laser for atrophic acne scars were retrospectively reviewed. Icepick, rolling, and boxcar scars were counted using photographs, and acne scar reduction efficiency (ASRE%; the percentage reduction of post-acne scar count from baseline counts) was calculated. The median count of each scar type was significantly reduced at the end of the final session. Boxcar scars responded better (median ASRE 59.2%) than rolling (ASRE 40.6%, p = 0.017) and icepick scars (ASRE 19.1%, p = 0.010). Concomitant isotretinoin use resulted in a greater ASRE and a significantly greater improvement in icepick scars. Patients aged 25years or younger showed a higher ASRE, with a greater improvement in boxcar scars. 1550-nm fractional laser treatment for atrophic acne scars was more effective in patients who were younger and taking isotretinoin concurrently.

Tripeptide and hexapeptide topical as adjunct to nonablative fractional resurfacing for photodamage: A randomized split-face trial.

Topical adjuncts have been investigated to improve clinical outcomes associated with laser resurfacing for photodamage and cutaneous aging. One such product is a tripeptide/hexapeptide serum, which has been shown to increase dermal collagen and elastin as well as improve postprocedural recovery following treatments. A randomized, blinded, split-face, comparative trial was performed to assess the utility of a tripeptide/hexapeptide serum as a peri-procedural adjunct to nonablative fractional laser resurfacing. A total of 20 subjects were enrolled. Each hemiface was randomized to either tripeptide/hexapeptide serum or bland moisturizer for twice daily application starting 14days prior to first laser treatment and continuing until 60days after. All subjects received 2 treatments to entire face approximately 1month apart with 1927nm thulium nonablative fractional laser. Clinical measures and immediate postprocedural recovery were assessed. For each hemiface, scores improved for all measures, including global photodamage, lentigines, pores, radiance, texture, and tone at 30 and 60days. The tripeptide/hexapeptide serum had greater improvements for all measures at both time points, except for radiance at 60days, which was equal. In cases where clinical ratings differed between sides, tripeptide/hexapeptide serum more frequently had the superior outcome. Overall, subjects were satisfied with tripeptide/hexapeptide serum. No significant adverse events were observed. Addition of tripeptide/hexapeptide serum as a peri-procedural adjunct to nonablative fractional laser resurfacing improved various clinical measures of photodamage and cutaneous aging and the immediate postprocedural recovery. The tripeptide/hexapeptide serum was demonstrated to be safe, well-tolerated, and well-liked by subjects.

Cells to Surgery Quiz: April 2019

Cells to Surgery Quiz: April 2019

Lidocaine-induced potentiation of thermal damage in skin and carcinoma cells.

Lidocaine acts as a local anesthetic by blocking transmembrane sodium channel permeability, but also induces the synthesis of heat shock proteins and sensitizes cells to hyperthermia. A previous study reported two cases of deep focal skin ulceration at points corresponding to depot local lidocaine injection sites after treatment with non-ablative fractional resurfacing and it was hypothesized that lidocaine had focally sensitized keratinocytes to the thermal damage of laser treatment. The objective of this study was to investigate whether lidocaine potentiates hyperthermia damage to both normal and cancerous skin cells using an in vitro model. Normal skin cell lines (fibroblasts, keratinocytes), skin cancer cell lines (melanoma, basal cell carcinoma), and a mucosal cancer cell line (cervical carcinoma) were exposed to various concentrations of lidocaine (0-0.3%) with or without hyperthermia (37°C, 42°C). Compared to normal skin cells, we demonstrate that cancer cell lines show significantly increased cell toxicity when a moderate temperature (42°C) and low lidocaine concentrations (0.1-0.2%) are combined. The toxicity directly correlates with a higher percentage of cells in S-phase (28-57%) in the cancer cell lines compared to normal skin cell lines (13-19%; R-square 0.6752). These results suggest that lidocaine potentiates thermal sensitivity of cell cycle active skin cells. The direct correlation between cell toxicity and S-phase cells could be harnessed to selectively treat skin and mucosal cancer cells while sparing the surrounding normal tissue. Additional research pre-clinically and clinically using several different heat sources (e.g., lasers, ultrasound, etc.) and lidocaine concentrations is needed to confirm and optimize these results. Lidocaine-enhanced hyperthermia may provide a non-invasive, alterative treatment option for highly proliferating, superficial skin, and mucosal lesions such as cancer or warts. Lasers Surg. Med. 51:88-94, 2019. © 2018 Wiley Periodicals, Inc.

Cosmetic approach to the Asian population.

The types of cosmetic procedures favored by Asian individuals are unique and tailored to their anatomical differences. Thus, a customized approach is taken for different cosmetic procedures, ranging from neurotoxins and fillers to nonablative fractional resurfacing. The purpose of this review article is to identify the different types of cosmetic procedures commonly sought by Asian individuals and to understand how these different procedures are customized toward their aesthetic preferences. This review integrates the findings from multiple clinical trials available on PubMed. The procedures listed are those that are mostly performed in dermatology offices.

Novel use of non-ablative fractional photothermolysis for café-au-lait macules in darker skin types.

The removal of café-au-lait macules (CALMs) in patients with darker skin phototypes poses a significant challenge due to limited available therapeutic options and increased risk of adverse effects, including permanent scarring and further dyspigmentation. Herein, we demonstrate the novel use of non-ablative fractional photothermolysis for the safe removal of CALMs in individuals with Fitzpatrick skin type (FST) IV-V. Retrospective analysis of four patients (FST IV-V) with CALMs revealed that three of these patients had greater than 50% clearance after multiple treatment sessions with the non-ablative fractional 1,550-nm erbium-doped fiber laser. This report demonstrates the utility and safety of non-ablative fractional resurfacing in the treatment of CALMs in darker skin phototypes. Lasers Surg. Med. 49:84-87, 2017. © 2016 Wiley Periodicals, Inc.

Low energy of nonablative fractional resurfacing laser in Indonesian skin: Study of clinical outcome and subjects’ perception

Low energy of nonablative fractional resurfacing laser in Indonesian skin: Study of clinical outcome and subjects’ perception

Nonablative Fractional Resurfacing

Since its introduction in 2004 by Manstein et al, fractional resurfacing has revolutionized the manner in which we treat photoaging. Fractional resurfacing delivers microscopic beams of light to the skin resulting in coagulation or vaporization of fragments of the epidermis and dermis. The wavelengths of these devices may vary, yielding different clinical results. This article will discuss the various uses of fractional ablative and nonablative devices available today.

Improvement in Lupus Pernio with the Successive Use of Pulsed Dye Laser and Nonablative Fractional Resurfacing

Improvement in Lupus Pernio with the Successive Use of Pulsed Dye Laser and Nonablative Fractional Resurfacing

Nonablative Fractional Resurfacing for the Treatment of Iatrogenic Hypopigmentation

Nonablative Fractional Resurfacing for the Treatment of Iatrogenic Hypopigmentation

Multimodal Treatment of Hypertrophic and Keloidal Scars

Introduction: Hypertrophic and keloidal scars are unwanted sequelae of wound healing. As multiple pathologic progenitors and mediators are responsible for these abnormal scars, single modality therapy is only intermittently successful. Multiple empiric therapies are now available which can be applied concomitantly or sequentially to address these uncomfortable and unsightly conditions. Materials and Methods: A 76-year-old woman underwent a rhytidectomy and blepharoplasty followed by perioral ablative laser resurfacing. During the ensuing 4 months, she developed circumferential perioral hypertrophic scars with foci of keloidal scar formation plus secondary evolution of microstomia. Results: Over an 18-month period, the patient received a single course of imiquimod cream, multiple injections of 5-fluorouracil and triamcinolone, multiple intense pulsed light treatments, and multiple nonablative fractional laser resurfacing treatments. At the conclusion of therapy, the patient achieved more than 90% resolution of hypertrophic and keloidal scarring. Conclusions: While knowledge of the pathogenesis of hypertrophic and keloidal scarring is evolving, at tempts at its resolution are empirical. Not surprisingly, the processes by which various therapies are effective continue to be argued. Nonetheless, administering multimodal therapy in an artful sequence can ameliorate many if not most hypertrophic and keloidal scars when treated at a relatively early stage.

Ablative Fractional Resurfacing in Topical Drug Delivery: An Update and Outlook

The effective delivery of therapeutic molecules to varied targets in the skin and elsewhere has been an area of ongoing research and development. To review the structure of the skin with an emphasis on topical drug delivery and to present the rationale for the use of ablative and nonablative fractional resurfacing in assisted drug delivery. Review of the currently available scientific literature on laser-assisted drug delivery. A number of strategies can be employed to enhance topical drug delivery. Ablative fractional resurfacing (AFR) has been demonstrated to be effective in enhancing drug delivery. Further studies are needed to assess the use of nonablative fractional resurfacing in assisted drug delivery. AFR-assisted drug delivery is a promising tool for the future of dermatology. We expect to see a number of agents to be paired with AFR for enhanced drug delivery. Further investigation is necessary to evaluate appropriate drug specific channel density and depth parameters. Factors that must be considered include the physicochemical properties of the drug, the target tissue, skin wounding, and cost when evaluating the drugs and conditions that will most benefit from this promising new drug delivery system.

Non-ablative fractional resurfacing in combination with topical tretinoin cream as a field treatment modality for multiple actinic keratosis: a pilot study and a review of other field treatment modalities

Background: Actinic keratoses (AK) are premalignant lesions occurring mainly in sun-damaged skin. Current topical treatment options for AK and photo-damaged skin such as liquid nitrogen and electrosurgery are not suitable for field treatment. Otherwise, therapies suitable for field treatment bring along considerable patient discomfort. Non-ablative fractional resurfacing has emerged as a logical treatment option especially for field treatment of AK. Objectives: To evaluate the clinical efficacy of fractional laser therapy for clearing AK and improving skin quality. To compare patient friendliness of the “fractional” therapy with those reported for other field treatment modalities. Materials & methods: Ten patients with Fitzpatrick skin type I to III with multiple AK and extensive sun-damaged skin, received 5–10 sessions with a 4-week interval using a 1550 nm Erbium-Glass Fractionated laser (Sellas, Korea). Four weeks and 24 weeks after the last treatment the clinical results were evaluated by an independent physician. Results: The mean degree of improvement, in terms of reduction in the number of AK and improvement of skin texture, was 54% on a 4 point PGA scale, and persisted for approximately 6 months. The biggest advantage of fractional laser treatment, besides the eradication of AK and a clear rejuvenation effect, is the absence of “downtime”. Conclusion: Fractional non-ablative resurfacing induces significant reduction in the number of AK and improves the skin quality. Also all patients preferred fractional laser therapy above other AK treatment modalities.

Treatment of burn scars with the 1,550 nm nonablative fractional Erbium Laser

Scarring is a major source of morbidity in patients with burns. Burn scars are difficult to treat and are among the worst scars seen in clinical medicine. Fractional laser resurfacing is a promising treatment option because of its unique wound healing response and depth of penetration. To evaluate the efficacy of nonablative fractional resurfacing as a therapeutic option for extensive cutaneous scarring in burn patients. Prospective, single-arm, pilot study. Ten subjects with second and third degree burn scars were treated with five nonablative fractional resurfacing treatments given at 4-week intervals. Three independent investigators evaluated subject outcomes at 3 months post-treatment (primary outcome); patients also provided subjective assessments of improvement (secondary outcome). Nonablative fractional resurfacing resulted in overall improvement in 90% of subjects, as determined by independent investigators; improvements were moderate to excellent in 60%. Ninety percent of subjects had improved skin texture, 80% had improved dyschromia, and 80% had improved hypertrophy/atrophy. Patients' self-reports also revealed moderate to excellent improvements (on average) in burn scar area, and significant improvements in self-esteem at 3 months post-treatment (P = 0.03). Small sample size and lack of control group. Fractional resurfacing is a promising new treatment modality for burn scars. We should continue to identify novel approaches and management strategies for the spectrum of diverse burn scars so that we can better treat this patient population.

Repigmentation of Hypopigmented Scars Using an Erbium-Doped 1,550-nm Fractionated Laser and Topical Bimatoprost

Hypopigmented scarring is a challenging condition to treat, with current treatments showing limited efficacy and temporary results. Nonablative fractional resurfacing has been demonstrated to be an effective and safe modality in the treatment of hypopigmented scars. To demonstrate the efficacy and safety of combining fractional resurfacing with topical bimatoprost and topical tretinoin or pimecrolimus for the treatment of hypopigmented scars. Fourteen patients with hypopigmented scars were treated with a mean of 4.5 sessions of a fractionated 1,550-nm erbium-doped laser at 4- to 8-week intervals and subsequently started topical bimatoprost and tretinoin or pimecrolimus. An independent physician evaluated digital photographs taken before and 4weeks after the last laser treatment using a quartile grading scale (grade 1, ≤25% improvement; grade 2, 26-50% improvement; grade 3, 51-75% improvement; grade 4, >75% improvement). Five patients had >75% improvement in hypopigmentation, and 12 had >50% improvement. After a mean follow-up of 20.1months, all patients demonstrated prolonged results. Side effects were limited to transitory post-treatment edema and erythema. The combination of fractional resurfacing, topical bimatoprost, and tretinoin or pimecrolimus is a potential effective resource for the treatment of hypopigmented scars, with long-lasting results.

The 1540-nm Nonablative Fractional Photothermolysis for Facial Surgical Scars

Introduction: Nonablative fractionated photothermolysis creates microscopic zones of thermal damage extending down into the dermis. The epidermis is left intact, allowing for rapid healing with minimal downtime for the patient. The deep heating of the dermis can help with rejuvenation of the skin by promoting neocollagenesis. The purpose of this study is to evaluate the effectiveness of 1540-nm nonablative fractional photothermolysis for facial surgical scars. Materials and Methods: Four patients with varying Fitzpatrick skin types had facial surgical scars treated with a 1540-nm nonablative fractionated photothermolysis. Results: All patients showed marked improvement in the appearance of their scars with no adverse pigmentary changes. The 1540-nm nonablative fractional resurfacing laser should be considered a first-line treatment for postsurgical scarring. Conclusions: Nonablative fractional photothermolysis with a 1540-nm wavelength is an excellent method to improve the appearance of facial surgical scars. It can be done with a minimum amount of downtime and should be safe for all skin types.

Effective Treatment of Atrophic and Icepick Acne Scars Using Deep Non-Ablative Radiofrequency and Multisource Fractional RF Skin Resurfacing

Background and Objectives: Effective treatment for atrophic (depressed) and icepick acne scars requires treatment of both epidermis—for roughness, texture and hyperpigmentation, and the dermis—for collagen remodeling. All first generation radiofrequency systems allow nonablative RF treatment while a few others allow simple bipolar Fractional RF skin resurfacing. The FDA cleared multisource radiofrequency therapy system (EndyMed PRO, EndyMed Ltd., Cesarea, Israel) allows, for the first time, phase controlled multisource RF for both deep (up to 11 mm) non ablative RF and fractional RF skin resurfacing on the same treatment device. Study Design/Materials and Methods: Ten subjects with atrophic acne scars were enrolled in the study. Patients were photographed using standardized methods. In each treatment session, each patient received a full face 3DEEP non ablative skin tightening treatment followed by a Fractional skin resurfacing treatment. The treatment sessions were repeated once a month to a total of up to 4 treatments. Results: All subjects experienced mild-moderate edema and erythema as an immediate response to treatment. Edema resolved after up to three hours post treatment and erythema lasted up to 2 days. Micro ablative crusts were formed 1 - 2 days post treatments and lasted up to 5 days on facial areas. Patients' photographs—before each treatment session and 1 and 3 months after the last session—were graded according to the accepted Cosmetic Improvement Scale. All patients obtained significant skin improvement. Seventy percent of patients had 50% - 75% improvement one month after the third treatment session while the other thirty percent experienced a 25% - 50%. Discussion and Conclusions: The presented results describe for the first time a new treatment system (EndyMed PROTM) that allows both deep non ablative RF delivery and Fractional skin resurfacing on the same treatment platform. This work shows the synergy of combining these two applications for the improvement of acne scars, as well as for some secondary possible pigmentation and vascular improvement.

The use of non‐ablative fractional resurfacing in Asian acne scar patients

Non-ablative fractional resurfacing (NA FR) has been shown to be effective for photorejuvenation and acne scarring. Previous studies indicated that density, more than pulse energy, was associated with post-inflammatory hyperpigmentation (PIH) in Asians. The objective of this retrospective study was to assess the efficacy and complications of eight passes of NA FR ('full-NA FR') with the 1,550 nm erbium-doped fibre fractional laser (Fraxel SR laser system, Solta Medical, Hayward, CA) versus four passes ('mini-NA FR') with comparable pulse energy and treatment level as 'full-NA FR', but double the number of treatment sessions in Asian acne scar patients. Forty-seven Asian atrophic facial acne scar patients who received full-face full-NA FR or mini-NA FR treatments between December 2005 and February 2009 were included. All photographic images captured with the Canfield Visia CR system at baseline and follow-ups were assessed for clinical efficacy and complications by an independent, non-treating and blinded physician. The total treatment densities for full-NA FR and mini-NA FR were 442.5 and 210.5 MTZ/cm(2), respectively. For full-NA FR, the PIH risk was 18.2% with cross-polarized images compared to 6.0% for mini-NA FR. This difference was statistically significant (P < 0.001). Improvement in skin texture, acne scarring, enlarged pores and overall pigmentation irregularity all reached statistical significance at last follow-up compared to baseline. There was no statistically significant difference in clinical efficacy between three full-NA FR and six mini-NA FR treatments. NA FR was effective and safe in Asians. By reducing the number of passes and the total treatment density, the risk of PIH could be reduced. Meanwhile, clinical efficacy could be maintained by increasing the total number of treatment sessions.

Letter: Eyelid Tightening and Improved Aperture through Nonablative Fractional Resurfacing

*Hospital de Clinicas de Porto Alegre, Department of Ophthalmology and Otorhinolaryngology, Universidade Federal do Rio Grande do Sul, School of Medicine, Rio Grande do Sul, Brazil